Rheumatoid arthritis classification: Difference between revisions
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{{CMG}}; {{AE}} {{MKK}} | {{CMG}}; {{AE}} {{MKK}} | ||
==Overview== | ==Overview== | ||
There is no established system for the classification of [disease | There is no established system for the classification of [[rheumatoid arthritis]]. Depending on the presentation of [[rheumatoid arthritis]], it is classified into typical classic [[rheumatoid arthritis]] and palindromic [[rheumatism]]. The classification criterion for the diagnosis of rheumatoid arthritis according to American College of Rheumatology, uses 4 parameters including [[joint]] involvement, [[serology]], duration of [[symptoms]], and acute phase reactants. If the score is more than 6 according to this criteria, the disease is classified as definite [[rheumatoid arthritis]]. | ||
==Classification== | |||
There is no established system for the classification of [[rheumatoid arthritis]]. Depending on the presentation of [[rheumatoid arthritis]], it may be classified as follows: | |||
[ | *Typical/classic [[rheumatoid arthritis]]: | ||
**Disease onset is insidious and it involves early [[Metacarpophalangeal joint|metacarpophalangeal]] (MCP) and [[Proximal interphalangeal joints|proximal interphalangeal]] (PIP) joints of the fingers, the [[interphalangeal joints]] of the [[thumbs]], the wrists, and the [[Metatarsophalangeal articulations|metatarsophalangeal]] (MTP) joints of the [[toes]].<ref name="pmid970994">{{cite journal |vauthors=Fleming A, Crown JM, Corbett M |title=Early rheumatoid disease. I. Onset |journal=Ann. Rheum. Dis. |volume=35 |issue=4 |pages=357–60 |date=August 1976 |pmid=970994 |pmc=1007396 |doi= |url=}}</ref><ref name="pmid4700332">{{cite journal |vauthors=Jacoby RK, Jayson MI, Cosh JA |title=Onset, early stages, and prognosis of rheumatoid arthritis: a clinical study of 100 patients with 11-year follow-up |journal=Br Med J |volume=2 |issue=5858 |pages=96–100 |date=April 1973 |pmid=4700332 |pmc=1589106 |doi= |url=}}</ref> | |||
*Palindromic [[rheumatism]]: | |||
**The onset is episodic. | |||
**Different [[joints]] are affected at different times or sequentially. | |||
[ | |||
The | |||
'''The 2010 American College of Rheumatology classification criteria for diagnosis of rheumatoid arthritis:'''<ref name="pmid20872595">{{cite journal |vauthors=Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G |title=2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative |journal=Arthritis Rheum. |volume=62 |issue=9 |pages=2569–81 |date=September 2010 |pmid=20872595 |doi=10.1002/art.27584 |url=}}</ref><ref name="pmid12415587">{{cite journal |vauthors=Maksymowych WP, Suarez-Almazor ME, Buenviaje H, Cooper BL, Degeus C, Thompson M, Russell AS |title=HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis |journal=J. Rheumatol. |volume=29 |issue=11 |pages=2319–26 |date=November 2002 |pmid=12415587 |doi= |url=}}</ref> | |||
'''The 2010 American College of Rheumatology classification criteria for diagnosis of rheumatoid arthritis:'''<ref name="pmid20872595">{{cite journal |vauthors=Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G |title=2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative |journal=Arthritis Rheum. |volume=62 |issue=9 |pages=2569–81 |date=September 2010 |pmid=20872595 |doi=10.1002/art.27584 |url=}}</ref> | |||
The 2010 | The 2010 American College of Rheumatology criteria rates various variables on a scale from 0-10 points. The points are assigned in four separate domains of signs and symptoms: | ||
1) Joint involvement | 1) [[Joint]] involvement | ||
2) Serology | 2) [[Serology]] | ||
3) Duration of symptoms | 3) Duration of [[symptoms]] | ||
4) Acute phase reactants | 4) Acute phase reactants | ||
Patients are | Patients are classified as definite [[Rheumatoid arthritis|RA]] if the score of 6 or more points is seen according to the following criteria. The details of the scoring criteria are discussed below: | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="4" |The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis. | ! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" |The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis. | ||
|- | |- | ||
|'''Domains''' | |'''Domains''' | ||
| Line 59: | Line 36: | ||
|'''Score''' | |'''Score''' | ||
|- | |- | ||
| rowspan=" | | rowspan="4" |[[Joint]] Involvement | ||
| rowspan=" | | rowspan="2" |Median-large [[joint]]<sup>*</sup> | ||
|2-10 | |2-10 | ||
|1 | |1 | ||
| Line 70: | Line 44: | ||
|2 | |2 | ||
|- | |- | ||
| rowspan="2" |Small joints<sup> | | rowspan="2" |Small [[joints]]<sup>**</sup> | ||
|4-10 | |4-10 | ||
|3 | |3 | ||
|- | |- | ||
|>10 | |>10*** | ||
|5 | |5 | ||
|- | |- | ||
| rowspan="3" |Serology | | rowspan="3" |[[Serology]] | ||
|No positive for either RF or anti-CCP | |No positive for either [[RF]] or anti-[[CCP]] | ||
| | | | ||
|0 | |0 | ||
| Line 90: | Line 64: | ||
|3 | |3 | ||
|- | |- | ||
|Duration of synovitis | |Duration of [[synovitis]] | ||
| +/> six weeks | | +/> six weeks | ||
| | | | ||
| Line 96: | Line 70: | ||
|- | |- | ||
| rowspan="2" |Acute phase reactants | | rowspan="2" |Acute phase reactants | ||
|Neither CRP or ESR is abnormal | |Neither [[CRP]] or [[Erythrocyte sedimentation rate|ESR]] is abnormal | ||
| | | | ||
|0 | |0 | ||
| Line 105: | Line 79: | ||
|- | |- | ||
| colspan="4" | | | colspan="4" | | ||
* Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment. | <sup>*</sup>Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment. Shoulder, elbow, knee, and ankle joints are included. | ||
<sup>**</sup> Small joints refer to metacarpophalangeal, proximal interphalangeal, second through 5th metatarsophalangeal, thumb interphalangeal and wrist joints | |||
<sup>***</sup> In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large additional small joint joins as well as other such as temporomandibular, acromioclavicular, sternoclavicular | |||
|} | |} | ||
Latest revision as of 14:26, 23 April 2018
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Risk calculators and risk factors for Rheumatoid arthritis classification | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
There is no established system for the classification of rheumatoid arthritis. Depending on the presentation of rheumatoid arthritis, it is classified into typical classic rheumatoid arthritis and palindromic rheumatism. The classification criterion for the diagnosis of rheumatoid arthritis according to American College of Rheumatology, uses 4 parameters including joint involvement, serology, duration of symptoms, and acute phase reactants. If the score is more than 6 according to this criteria, the disease is classified as definite rheumatoid arthritis.
Classification
There is no established system for the classification of rheumatoid arthritis. Depending on the presentation of rheumatoid arthritis, it may be classified as follows:
- Typical/classic rheumatoid arthritis:
- Disease onset is insidious and it involves early metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the fingers, the interphalangeal joints of the thumbs, the wrists, and the metatarsophalangeal (MTP) joints of the toes.[1][2]
- Palindromic rheumatism:
- The onset is episodic.
- Different joints are affected at different times or sequentially.
The 2010 American College of Rheumatology classification criteria for diagnosis of rheumatoid arthritis:[3][4]
The 2010 American College of Rheumatology criteria rates various variables on a scale from 0-10 points. The points are assigned in four separate domains of signs and symptoms:
1) Joint involvement
2) Serology
3) Duration of symptoms
4) Acute phase reactants
Patients are classified as definite RA if the score of 6 or more points is seen according to the following criteria. The details of the scoring criteria are discussed below:
| The 2010 American College of Rheumatology classification criteria for rheumatoid arthritis. | |||
|---|---|---|---|
| Domains | Description | Number | Score |
| Joint Involvement | Median-large joint* | 2-10 | 1 |
| 1-3 | 2 | ||
| Small joints** | 4-10 | 3 | |
| >10*** | 5 | ||
| Serology | No positive for either RF or anti-CCP | 0 | |
| At least one of these test positive at the high titer | 2 | ||
| At least one of these test positive at low titer | 3 | ||
| Duration of synovitis | +/> six weeks | 1 | |
| Acute phase reactants | Neither CRP or ESR is abnormal | 0 | |
| Abnormal CRP or ESR | 1 | ||
|
*Distal interphalangeal,1st carpometacarpal and 1st tarsometatarsal joints are excluded from the assessment. Shoulder, elbow, knee, and ankle joints are included. ** Small joints refer to metacarpophalangeal, proximal interphalangeal, second through 5th metatarsophalangeal, thumb interphalangeal and wrist joints *** In this category, at least one of the involved joints must be a small joint; the other joints can include any combination of large additional small joint joins as well as other such as temporomandibular, acromioclavicular, sternoclavicular | |||
References
- ↑ Fleming A, Crown JM, Corbett M (August 1976). "Early rheumatoid disease. I. Onset". Ann. Rheum. Dis. 35 (4): 357–60. PMC 1007396. PMID 970994.
- ↑ Jacoby RK, Jayson MI, Cosh JA (April 1973). "Onset, early stages, and prognosis of rheumatoid arthritis: a clinical study of 100 patients with 11-year follow-up". Br Med J. 2 (5858): 96–100. PMC 1589106. PMID 4700332.
- ↑ Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (September 2010). "2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative". Arthritis Rheum. 62 (9): 2569–81. doi:10.1002/art.27584. PMID 20872595.
- ↑ Maksymowych WP, Suarez-Almazor ME, Buenviaje H, Cooper BL, Degeus C, Thompson M, Russell AS (November 2002). "HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis". J. Rheumatol. 29 (11): 2319–26. PMID 12415587.